Matters of the heart

Amy was 28 and pregnant when she had a heart attack. Despite crushing chest pain, sweating and nausea, “I was told it was the baby kicking my diaphragm,” she relates.

Her symptoms continued on and off for two years. First they were attributed to exercise-induced asthma, then to pleurisy. It took a severe episode and a stress test to finally diagnose what was happening. Amy was promptly hospitalized, only to have a massive heart attack while undergoing an angiogram. Since then, she has had 11 stents implanted and gone through two bypass surgeries.

Her story, and those of more than 20 other women, appears on the Heart Sisters blog as a compelling illustration of what it’s like to experience a heart attack – and a reminder that we often know less than we think about recognizing a heart attack and taking appropriate action.

This is especially true for women’s heart attacks. The personal stories at Heart Sisters have some common threads – most of these women had chest pain, and many of them also had heartburn, nausea and sweating. Additionally, several of them reported fatigue, flu-like symptoms, and back or arm pain. Although pain, heartburn and sweating among men generally raise the index of suspicion for a heart attack, many of these women were initially told they had a virus or a panic attack, or that their symptoms were pregnancy-related.

It has only been in recent years that heart attacks in women have been studied more closely. One of the things that has been learned is that women’s heart attacks often don’t follow the standard pattern we’ve come to associate with what Heart Sisters blogger Carolyn Thomas calls the “Hollywood heart attack,” in which the victim clutches his chest (usually it’s a he) and perhaps falls to the ground.

Here’s an even bigger revelation, though: Overall, Americans aren’t very good at recognizing a heart attack, period. Nor are they very good about taking correct action if they suspect they or someone they know is having a heart attack.

In an article that appeared a few months ago in Future Cardiology, author Jing Fang cites some rather disturbing statistics:

… National surveillance data show that the awareness of heart attack symptoms is still low among US adults – only 31% of US adults knew all five symptoms of a heart attack in 2005, and this percentage did not improve when compared with 2001. Further, a study demonstrated that the delay in seeking treatment for a heart attack has changed little in recent decades, despite increased public awareness of the benefits of reperfusion therapy.

There’s more. Although awareness of women’s risk of having a heart attack has grown substantially among both white women and women of color, their knowledge of the warning signs of a heart attack hasn’t improved.  A survey conducted in 2009 among 3,000 women found that while more than half knew cardiovascular disease was the leading cause of death for women, only a minority knew that shortness of breath, chest tightness, nausea and fatigue were heart attack symptoms. And only about half said they would call 911 if they thought they were having a heart attack.

If you talk to local paramedics, many of them will tell you there’s a denial factor among men as well as women. Sometimes they delay calling 911 because they’re stoic or embarrassed. Sometimes they decide to drive to the emergency room themselves.

Indeed, despite all the public awareness campaigns about what to do if you think you’re having a heart attack, there still seems to be a fair amount of confusion. From the Future Cardiology article:

The symptoms of a heart attack may vary and may be similar to symptoms of other diseases, consequently a person may think that they have diseases other than heart attack and, therefore, wait too long before calling 911 or going to the hospital. Moreover, even individuals who are aware they are experiencing a heart attack may delay seeking care owing to a number of factors including fear, concerns about cost, self-treatment with medication, distrust of the healthcare system, consulting with family members, and embarrassment about calling emergency medical services if the condition turned out not to be a heart attack.

It appears there’s still work to be done on the education front.

How well do you think you could recognize the signs of a heart attack? Take the American Heart Association quiz here. You can also take the American Heart Association’s online heart attack risk assessment here.

3 thoughts on “Matters of the heart

  1. Hello Anne and thanks so much for the plug re my Heart Sisters blog, and for this comprehensive and excellent article.

    You are so right about most of us being woefully ignorant about heart attack symptoms. That’s why I was so pleased to participate this month in the online media launch of a new “Make The Call – Don’t Miss a Beat” heart attack awareness campaign – it’s at It not only covers the most common heart attack symptoms, it urges us to CALL 911 when we think we might be having a heart attack.

    Working with The Spirit of Women’s “2012 Day of Dance”, the women working at the St. Vincent Hospital system in Pennsylvania even put this ‘Make The Call’ message into a musical exercise routine! Catch it at:

    Sadly, you are also right that, even when we know the most common heart attack symptoms, many of us do NOT seek help immediately. Researchers call this “treatment-seeking delay” behaviour. You may be familiar with Oregon researchers and their study on women heart attack survivors published in The American Journal of Critical Care; it identified six distinct types of this treatment-seeking delay behaviour. Fascinating (and uncomfortably familiar for many of us survivors!) – more at “Knowing & Going: Act Fast When Heart Attack Symptoms Hit” –

    Thanks again!

  2. Pingback: The weekly rundown, Feb. 16 | HealthBeat

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